Hospital care for First Nations people with dementia
In 2022–23, there were about 460 hospitalisations due to dementia (where dementia was the principal diagnosis or the main reason for the hospital admission) where the patient identified as a First Nations person.
First Nations men were slightly more likely to be hospitalised due to dementia (20 hospitalisations per 10,000 First Nations men) than First Nations women (18 hospitalisations per 10,000 First Nations women) (Table S12.15).
Refer to Hospital care for more information on overall hospitalisations for dementia in Australia and see the Technical notes for further information on hospitals data. For information about the quality of First Nations identification in hospitals data, see Indigenous identification in hospital separations data: quality report.
In 2022–23, the average length of stay among First Nations people for hospitalisations due to dementia was 16.9 days, slightly longer than that for non-Indigenous Australians (15.5 days) (Table S12.16).
There are many reasons why First Nations people may not want to use hospital services, such as: competing family and cultural obligations; distrust in the health system due to negative past and present experiences; a lack of culturally safe care options; communication barriers with medical staff, including barriers for First Nations people for whom English is a second language; limited access to health services in regional and remote locations requiring patients to receive care away from their community; high travel and other out-of-pocket costs, especially for people living in regional and remote locations (AHMAC 2017; Shaw 2016).
In 2018–19, 30% of First Nations Australians reported that they needed to, but did not see a health care provider in the 12 months prior. About one-third (33%) of those who did not see a health care provider when they needed to report a reason related to service availability or transport/distance: waiting time too long or the service was not available at time required (21%); they did not have transport or the service was too far away (13%); or the service was not available in the area (7%).
More information can be found in the Access to Services Compared to Need measure within the Aboriginal and Torres Strait Islander Health Performance Framework.
The age standardised rates (ASRs) for First Nations people differ from previous analysis due to updated age-structure used in the calculation of these rates. Previously, the upper age group was 65 years and older, with the current analysis instead using 85 and older which introduces several new 5-year age groups. This change results in higher ASRs due to high counts (numerator) but relatively low populations (denominator) in these age groups. Analysis has been back cast for previous years to allow comparison over time using these updated age groupings.
How did hospitalisations due to dementia end for First Nations people?
In 2022–23, 47% of First Nations people hospitalised due to dementia were discharged to their usual residence in the community or residential aged care, 8.7% were transferred to another acute hospital, 6.9% entered a new residential aged care, and 5% died (Figure 12.7; Table S12.17). This pattern is similar to all hospitalisations due to dementia, except that the proportion of First Nations people separated to a residential aged care service that was not their usual place of residence (6.9%) was nearly half that of all Australians (12.3%).
Figure 12.7: First Nations hospitalisations due to dementia: percentage by mode of separation in 2022–23
The bar chart shows how the proportion of separations to residential aged care services that are not the patient’s usual place of residence among First Nations people hospitalised due to dementia was nearly half that of all hospitalisations due to dementia.
| Mode of separation | First Nations people hospitalised due to dementia | All hospitalisations due to dementia |
|---|---|---|
| Discharged home | 41% | 38.9% |
| An(other) acute hospital | 8.7% | 8.4% |
| Statistical discharge (including from leave) | 29.7% | 27% |
| Died | 5% | 5.6% |
| Residential aged care service (not usual place of residence) | 6.9% | 12.3% |
| Residential aged care service (usual place of residence) | 6.3% | 5.8% |
- Percentages will not add up to 100% due to suppression of small numbers.
- Statistical discharge is an administrative process that occurs within an inpatient stay when the care type changes (e.g. A patient is admitted under Acute Care but is then discharged to Palliative Care).
Source:
AIHW analysis of National Hospital Morbidity Database
When First Nations people were hospitalised due to dementia, what other conditions did they have?
When First Nations people were admitted to hospital due to dementia, the most common diagnoses (additional and supplementary diagnoses), other than dementia were:
- hypertension
- ischaemic heart disease (also known as coronary heart disease)
- type 2 diabetes without complications
- constipation
- arthritis and osteoarthritis.
Some of these diagnoses are closely related to the modifiable risk factors for dementia, including hypertension and diabetes. For further information on the top 10 other diagnoses, see Table S12.18.
How did hospitalisations due to dementia for First Nations people vary by geographic area?
Given the small number of hospitalisations due to dementia for First Nations people in a given year, the rates of hospitalisations due to dementia presented in this analysis were aggregated over a 3-year period (2020–21, 2021–22 and 2022–23).
After adjusting for population differences, between 2020–21 and 2022–23, the crude rate of hospitalisations due to dementia for First Nations people aged 40 years and over, was:
- highest in Queensland (22 hospitalisations per 10,000 First Nations people) and was lowest in Victoria (11 hospitalisations per 10,000)
- highest in Major Cities (20 hospitalisations per 10,000 First Nations people) and was lowest in Remote and Very Remote regions (14 hospitalisations per 10,000) (Figure 12.8; Table S12.19).
Between 2020–21 and 2022–23, the rate of hospitalisation due to dementia among First Nations people varied by Indigenous Region (IREG), ranging from 8.8 hospitalisations to 27.5 hospitalisations per 10,000 people (Table S12.20).
Figure 12.8: First Nations hospitalisations due to dementia: number, crude rate, by state and territory and remoteness area between 2020–21 and 2022–23
A bar graph showing the number and crude rate of hospitalisations due to dementia among First Nations people between 2020–2021 and 2022–2023 in Australia and by remoteness area and state or territory.
First Nations hospitalisations with dementia
Previous sections have presented hospitalisations due to dementia (that is, when dementia was recorded as the principal diagnosis), but understanding hospitalisations with dementia (that is all hospitalisations with a record of dementia, whether as the principal and/or an additional diagnosis and/or a supplementary diagnosis) provides important insights on the wide-ranging conditions that can lead people living with dementia to use hospital services.
There were almost 3,600 hospitalisations with dementia among First Nations people in 2022–23, a 54% rise from 2016–17. The age-standardised rate also rose during this time from about 236 to 274 per 10,000 First Nations people (Figure 12.9; Table S12.21).
Figure 12.9: First Nations hospitalisations with dementia by sex: number, crude and age-standardised rate, between 2016–17 and 2022–23
The line graph shows an increase in the number, crude, and age-standardised rate of First Nations hospitalisations with dementia for both men and women.
What were the most common principal diagnoses for First Nations people when dementia was an additional or supplementary diagnosis?
In 2022–23 there were about 3,200 hospitalisations of First Nations people where dementia was an additional or supplementary diagnosis.
The most common principal diagnoses among these hospitalisations for First Nations people aged 40 years and over were:
- Problems related to medical facilities and other health care (7.1%)
- Other disorders of urinary system (3.7%)
- Delirium, not induced by alcohol and other psychoactive substances (3.5%).
Other common principal diagnoses recorded for these hospitalisations included pneumonia, sepsis, femur fractures and chronic conditions such as chronic obstructive pulmonary disease and diabetes (Figure 12.10; Table S12.22).
Figure 12.10: Common principal diagnoses for hospitalisations of First Nations people where dementia was an additional or supplementary diagnosis: percentage of hospitalisations, by sex in 2022–23
The bar chart shows that where dementia was an additional diagnosis, First Nations men were more likely to have a principal diagnosis of Pneumonia and Type 2 diabetes for hospitalisations, while First Nations women were more likely to have a principal diagnosis of a femur fracture and chronic obstructive pulmonary disease.
| Principal diagnosis | Men | Women | Persons |
|---|---|---|---|
| Problems related to medical facilities and other health care | 7.8% | 6.6% | 7.1% |
| Other disorders of urinary system | 2.9% | 4.4% | 3.7% |
| Delirium, not induced by alcohol and other psychoactive substances | 3.4% | 3.6% | 3.5% |
| Fracture of femur | 1.8% | 4.0% | 3% |
| Other chronic obstructive pulmonary disease | 2.4% | 4.0% | 3.3% |
| Pneumonia, organism unspecified | 4.0% | 2.3% | 3.1% |
| Type 2 diabetes mellitus | 3.9% | 1.8% | 2.7% |
| Other sepsis | 2.0% | 2.6% | 2.3% |
| Pain in throat and chest | 1.2% | 1.9% | 1.6% |
| COVID-19 | 1.8% | 2.2% | 2.0% |
- Hospitalisations include First Nations people aged 40 and over, hospitalised with dementia as an additional diagnosis.
- Refer to the technical notes for information on the ICD-10-AM codes for these principal diagnoses, available at Technical notes.
Source:
AIHW analysis of National Hospital Morbidity Database
AHMAC (Australian Health Ministers’ Advisory Council) (2017) Aboriginal and Torres Strait Islander Health Performance Framework 2017 report, Australian Health Ministers’ Advisory Council, Australian Government, accessed 17 August 2022.
Shaw C (2016) An evidence‑based approach to reducing discharge against medical advice amongst Aboriginal and Torres Strait Islander patients, The Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association, accessed 17 August 2022.